ER abuses
The overuse of Emergency Rooms has escalated dramatically in the past 10 years. Ask any Emergency Room physician, nurse or EMT and you will hear the same thing. Medicaid abuse is their single biggest problem. The Courier reports that Kentucky is now targeting ways to cut Medicaid costs and abuses. [Medicaid may cut frivolous ER use]
Every physician will tell you that by adding small co-pay to any emergency room visit or by denying payment for non emergency uses would help significantly. But what to do with the chronic abusers is another matter.
The article showed that 49 people in Kentucky on Medicaid visited the ER 50 or more times last year. Most of these were for narcotic or other drugs. I seriously doubt that anyone could believe that these individuals had 50 plus emergency health problems. The majority of Americans may go to the ER 1-2 times in a lifetime.
But the other major issue from Physicians is that if a patient is informed that their problem does not constitute an emergency and if they would refuse to treat them, there are too many attorneys just waiting to file suit.
If Kentucky and other states really want to address this problem, then they will have to also address the litigation issue and give hospitals and physicians some protection. Serious Tort reform is an absolute necessity to address the escalating health care costs.
Every physician will tell you that by adding small co-pay to any emergency room visit or by denying payment for non emergency uses would help significantly. But what to do with the chronic abusers is another matter.
The article showed that 49 people in Kentucky on Medicaid visited the ER 50 or more times last year. Most of these were for narcotic or other drugs. I seriously doubt that anyone could believe that these individuals had 50 plus emergency health problems. The majority of Americans may go to the ER 1-2 times in a lifetime.
But the other major issue from Physicians is that if a patient is informed that their problem does not constitute an emergency and if they would refuse to treat them, there are too many attorneys just waiting to file suit.
If Kentucky and other states really want to address this problem, then they will have to also address the litigation issue and give hospitals and physicians some protection. Serious Tort reform is an absolute necessity to address the escalating health care costs.
posted by Anonymous at 6:30 AM
9 Comments:
Healthblogger, kudos for making the commitment to do this blog properly. We're not always in agreement, but your is a welcome presence at the table.
Unfortunately, HB, there's no evidence correlating tort reform with lowering healthcare costs. In fact, research done by an independent Wall Street firm for the insurance industry says as much.
Several states have limited damages for years with no effect on the cost of healthcare or medical insurance. In fact, healthcare and insurance costs have escalated more quickly in some of those states than they did in states without limits.
When insurance companies find themselves in the position of assuming less risk, they simply pocket the extra money. Those savings are typically not passed on to the medical establishment or patients.
Again, any serious reform has to target the corporations in those industries and not just the individuals at their mercy.
If a person's right to seek damages is limited (thereby acting as an agent of risk management favoring the insurance companies), then those insurance companies must be compelled to lower rates in return for the protection. If they're not, the only beneficiary of tort reform is the insurance industry.
The problem with our system is not that the insurance companies are making too much money. It's that individuals can't afford health insurance or paying for medical services out of pocket.
There are no doubt people abuse the system but, as Brandon points out, ER use is often the most rational decision given circumstances.
Preventive care and education (ie, regular visits with medical personnel) would go a long way in avoiding non-emergency ER useage but, under our current system, unless you have employer provided insurance or live near a free clinic, a routine office visit can easily cost $100 out-of-pocket.
That certainly doesn't encourage regular check-ups or early treatment. Those in lower income brackets simply have to gamble that their condition won't get worse because they can't afford to do otherwise.
The article does not mention the threat of lawsuit, but I am very close friends with many ER physicians and have intimate working knowledge of the system. It is the major concern of Physicians. For your information, even if a primary care doctor does not give the ok to the emergency room for a medicaid visit(which is required in IN. and KY for them to be paid)the physician still will see the patient for fear of lawsuits.
The process is (1)medicaid patient signs in at the ER, (2)clerk or nurse calls primary provider listed on their card for approval and gives the doctor a brief history of their complaint,(3)doctor can decide to allow them to be seen, tell them to come to the office, or deny the visit.
Even on denials, once the patient has registered, the ER Doctors will see the patient no matter what the decision was.
Indiana has caps on malpractice claims and that is why premiums for physicians are less here than many other states and why so many Kentucky doctors are choosing to move primary offices here.
OB/GYN premiums have caused more than 5 physicians in Jeffersonville and New Albany to stop doing OB as of Jan. 2005
Physician access is getting worse because of the high premiums, tremendous paperwork, lower reimbursements and the frivolous lawsuits. Two major primary care offices are cancelling their medicaid contracts next month.
Majority of lawsuits are settled out of court primarily because it is cheaper than fighting the claim, not because the lawsuits have merit. The cost to prove that would be more than the settlement.
There are legitimate lawsuits that need to be filed, but for most people filing, the odds are better at getting a little settlement money from an insurance company than it is for winning the lottery. Most attorneys doing these cases don't charge unless they win, therefore it costs patients nothing to file a frivolous suit.
All of these issues need fixing.
But Healthcare is not a right.
It is a service oriented business and patients should be responsible for what they are purchasing.
If people can't see or understand this concept, they are ignorant of the facts or just fail to understand the real problems.
Recently, HB, I had to have my spine examined. The normal dull roar caused by my combination scoliosis/kyphosis (a congenital condition totally unavoidable no matter my own personal choices) had become aggravated by normal daily activities and the severe, acute pain was making it difficult to get out of bed in the morning, let alone go to work and be productive in the almighty capitalist system that pervades our country.
I decided it best to consult with the physician who had originally diagnosed the condition, knowing that my records and x-rays were already present in his office, making comparison easier and thereby reducing the need for additional labor and associated costs to reproduce or shuttle those records.
To my surprise, the doctor had moved his practice and the new was much busier. When I originally visited him, the doctor operated out of a modest suite and took the time necessary to fully explain the condition, treatment options, and possible consequences. He also showed up on time for his appointment. The total cost of the office visit was $75 dollars, including the portion paid for by insurance.
This time, I had to wait for two weeks for an appointment. This time, I had to wait for two hours for the doctor to finally show up for that appointment. This time, his office was located in a plushly furnished high-rise complex with a view of the city that, while admittedly beautiful, has nothing to do with the quality of care provided by the physicians who work there, regardless of unnecessary expense.
After finally being taken to an examination room, I waited for another 20 minutes. Boredom and frustration led me to wander the halls a bit, where I eventually found a coat rack where I admired an exquisite Italian designer coat.
The doctor finally arrived and told a nurse to take me down the hall for an x-ray without even acknowledging my presence in the room. After waiting for two other patients to be x-rayed, they shot a picture of my spine and I was directed to return to the examination room.
After another wait, the doctor returned with both my old and new x-ray. The curvature of my spine had increased slightly due to aging. The doctor quickly explained that while the problem was indeed worsening, I was still two degrees shy of the limit justifying surgery; therefore there was nothing he could do. He then proceeded to walk towards the door, without so much as saying goodbye.
Not being satisfied, I stopped him with a question: What am I supposed to do between now and two degrees more of deterioration? He answered that I should take Tylenol and started to leave again.
I stopped him with another question: Was there anything I could do besides resigning myself to constant drug taking that may help to alleviate the pain and avoid the necessity of further care? Therapy? Exercise? Obviously frustrated, he answered that he thought they used to have some information about exercise in a file somewhere and asked the nurse if she could try to track it down because he had to leave.
Thankfully, the nurse found the file and apologized for the doctor's behavior.
After getting dressed, I started back down the hallway towards reception to make the required co-payment. I passed the doctor's private office on the way out and heard him on the phone apologizing for being late, explaining that he had been "held up" by a patient.
When I reached the front desk, the office worker explained that my portion was $25 but that the total would be $150 ($37 a minute), not including the x-ray which would be billed separately. After paying for my portion, I noticed the doctor at the elevator, wearing the designer Italian coat I had seen on the rack earlier. I hurried to try to catch him, quite frankly to complain about the pitiful service I had received for such an exorbitant price, but I missed him.
Luckily, as I was getting into my car in the parking garage, I spotted the doctor getting into his own late model Mercedes convertible. Out of curiosity, I followed him out of the garage.
Had he been apologizing on the phone that my forcing our much-anticipated visit to last 4 minutes rather than two minutes had made him late for surgery? Nope. He drove his convertible to Vincenzo's, where the valet parking attendant took his keys, allowing him to rush in quickly to his next scheduled "appointment".
While certainly not every physician is a pompous, non-caring rich guy, this is a scenario repeated thousands of times a day throughout the country for those of us lucky enough to have healthcare coverage. This, in some ways, is the good news.
If thinking that my ability to stand upright and be productive is more important than his ability to drive a new Mercedes convertible (all the while complaining about his rising costs) makes me ignorant, then so be it.
The decision to purchase healthcare is very different from the decision to purchase cable television and any attempt to compare them as services is disingenuous.
The only reason that we're having this conversation is that because we, as a society, have decided that the ability of a certain segment of the population to maintain its extravagant lifestyle is more important than the ability of others to receive even the most basic healthcare.
Our system is broken because of greed and the influence of a certain demographic to get that greed written into public policy.
Your example of physicians moving to Indiana doesn't speak at all to the prices being paid by patients. Access has to include affordability as a component or the mere presence of additional doctors means nothing. Did those doctors move to avoid bankruptcy or did they just simply figure out that they could make more money in Indiana?
Your example of OB/GYN premiums again doesn't address those problems.
I can cite example after example just locally of people who've struggled for months, often to no avail, to get insurance companies to simply do what they contractually agreed to do in return for their monthly premiums and pay totally legitimate claims. It's happened to me personally twice.
Does anyone actually wonder why the average citizen is so willing to fight insurance companies? Getting anything from an insurance company other than a hard time automatically elevates the average joe into a public opinion Robin Hood.
Major pharmaceutical companies in the U.S. spend more each year on marketing than they do on the research and development that they swear causes their drug prices to be so high, even though they continue to sell those same drugs at a profit in other countries at much lower prices.
While pleading their case, those same companies more often than not conveniently leave out the fact that most major drug breakthroughs have come not from their own private research but from federal tax dollar funded programs. It doesn't take certified medical expertise to realize that, should they ever actually make a major breakthrough in treating or curing disease, almost no marketing would be necessary. "Gee, I didn't know they had cured (insert disease here) until I saw that Super Bowl commercial."
My guess is that that commercial wouldn't alert the public to the fact that drug companies enjoy higher profit margins than nearly every other industry in the United States, either.
And yes, a lot of doctors continue to make so much money that the words "doctor" and "wealthy" have become nearly synonymous in our language.
You'll note that in my earlier argument, I didn't argue against tort reform (although I think damage limits are a rather absurd way of doing that). I only stated that tort reform, if not paired with substantial industry regulation, would not solve the problem.
While healthcare may not be a documented right in our Constitution, the most basic ingredient in the recipe of life, liberty, and the pursuit of happiness is one's ability to stay alive. Crying out for tort reform that puts the total onus of responsibility on individual citizens while virtually ignoring the sickening excesses of some of those in the medical and insurance industries is akin to stating that the maintenance of certain profit margins is more important than the act of breathing.
In response to Bluegill:
First, my prayers are with you for your disability and chronic pain I am sure you have with the condition you describe.
I make no excuses for the pompous, arrogant attitude of the physician you described. It sounds as if he was probably a specialist and not a primary care physician. As in every field, there are a few who give the rest a bad reputation.
A few facts:
Physicians must do 4 years of college, then 4 years of Medical School and then anywhere from 3 years(for family practice) to 7-9 additonal years for something like neurosurgery. All of these years they are either paying for the education or during residency making a salary of $26,000-$30,000/year and working an average of 80 hours.
This puts the average physician at least $60,000 in debt before they can ever open their own office or join one.
They are usually around 30 years old before they ever get their real "doctor salary"
Since basic medical care is what we are discussing, the average pediatrician in Louisville after the 11 years of college, med school, and residency starts out at $60-75,000. Internists have 12 years training and start at 80,000-$100,000
They have no health insurance unless they pay for it, no retirement plan unless they pay for it, no disability unless they pay for it and then usually after 1-3 years they may have an opportunity to buy into the practice at another 50-100,000. Malpractice will be anywhere from 15-25,000 a year.
The average primary care doctor usually has more office staff, more overhead expenses and more on-call hours than specialist. They are not what you describe as "exceedinly wealthy".
My primary care doctors office is always on time, courteous, and tries very hard to meet my needs.
They see people with no insurance and have a Flat fee of 25-30 dollars and then always tries to give those patients sample medicines. Two of them in my doctor's office drive old pickups, they make rounds at the hospital 7 days a week and keep their phone numbers listed in the phone book.
I do believe that being in the greatest country on earth we have an obligation to provide basic medical care.
But it is not a right. During the last 30 years when big companies paid 100% of health insurances for employees, the value to the individuals became less and less. Any time something is free, it loses its intrinsic value. We have created a society that believes healthcare should be provided at no cost and created an entitlement minded generation that cannot continue the way it is.
There are abuses, and there are opportunities for improvement in all areas.
Again, my thoughts are with you and I apologize as it sounds as if this topic hit a sensative area.
Good stuff.
No need to apologize, HB. These are conversations that need to take place and you're providing the impetus for them. This is good stuff.
BTW, who's your doctor? You can contact me privately if you like. Having seen my own primary care office implode over the past ten years and checked out several others since, your office is an anomaly based on my experiences.
You and I seem to agree that education is way too expensive in this country and, as such, limits what an educated person can do upon the completion of formal training.
I'll note though, that the debt level you describe is not at all uncommon in other fields and many of those graduates go on to do non-profit work for much less money with little to no hope of ever receiving much of a raise. $60-75,000 is more than many of them will ever make.
We could discuss this topic endlessly and probably never agree. But we will never know what the cost of medicine would be unless there truly was limits to awards and protection from lawsuits.
There will always be a lawyer who can justify a suit. I have seen too many examles of clear cut malpractice and also of clear cut suits that were not malpractice but were settled because it was cheaper than the fight.
The government should set up a "study" in which 100-200 malpractice cases were all taken to trial with the attorneys being paid for their time and expense. Each one should truly be tried on their merits and an independent jury that was selected should hear each case. Then we could truly see what percentage of typical cases are really legitimate.
Will this ever happen? You and I both know the answer. There is too much money involved in this area of law, and the majority of congress who makes legislation are lawyers, not physicians.
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